慢性稳定型冠心病的核素心肌灌注显像临床应用进展

多项临床试验证明，核素心肌灌注显像在冠心病诊断、危险度分层、预后判断、病人处理方案等方面具有突出的作用和优越的价值。在ACC/AHA(美国心脏病学院／美国心脏学会)有关冠心病和核心脏病学指南中，心肌灌注显像的上述作用得到了充分肯定。合理应用该项技术可以提高对冠心病诊断、处理的整体水平，并使有限的医疗资源得到更合理利用，这在我国目前显得十分迫切和需要。     

核素心肌显像在冠心病处理决策中的合理应用及其原理

核素心肌显像在冠心病诊断、危险度分层及预后判断方面积累了大量资料,并可据此制定冠心病的有效处理策略。在ACC/AHA(美国心脏病学会/美国心脏协会)有关冠心病和核心脏病学指南中,核素心肌显像的上述作用得到了充分肯定。合理应用该技术可以提高我们对冠心病诊断处理的整体水平,并使有限的医疗资源得到更合理利用,目前这在我国显得十分迫切和必要。     

核素心肌显像在冠心病处理决策中的合理应用及其原理

核素心肌显像在冠心病诊断、危险度分层及预后判断方面积累了大量资料，并可据此制定冠心病的有效处理策略。在ACC／AHA(美国心脏病学会／美国心脏协会)有关冠心病和核心脏病学指南中,核素心肌显像的上述作用得到了充分肯定。合理应用该技术可以提高我们对冠心病诊断处理的整体水平,并使有限的医疗资源得到更合理利用，目前这在我国显得十分迫切和必要。     

核素显像识别存活心肌的临床应用进展

存活心肌的判断对冠心病患者治疗方案的选择及预后十分重要。^201Tl再注射法、硝酸甘油介入的静息^99Tc^m-sestamibi法增强了心肌灌注核素体层显像对存活心肌的检测能力，门控SPECT技术能在评估心肌灌注的同时计算LVEF(左心室射血分数)、局部室壁运动和局部室壁增厚率，具有符合线路的SPECT可以进行心肌代谢显像及灌注显像，其对存活心肌的检测能力可能接近于PET，而检查费用可大大降低。     

民航飞行人员核素心肌灌注显像结果分析

民航飞行人员核素心肌灌注显像结果分析顾祥华关键词（ＫＥＹＷＯＲＤＳ）心肌灌注显像（Ｍｙｏｃａｒｄｉａｌｐｅｒｆｕｓｉｏｎｉｍａｇｅ）冠心病（Ｃｏｒｏｎａｒｙｈｅａｒｔｄｉｓｅａｓｅ）中国图书资料分类法分类号Ｒ８５６．５冠心病可引起飞行人员空中突然失能...     

冠心病患者平面心肌灌注显像的临床意义

对１００例经冠状动脉造影证实冠状动脉狭窄≥５０％的患者进行了９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）平面心肌灌注显像，并将两种检查结果进行对比分析，以评价心肌灌注显像的临床价值。一、资料与方法１００例冠心病患者，男８５例，女１５例，平均年龄５７２（...     

核素显像识别存活心肌的临床应用进展

存活心肌的判断对冠心病患者治疗方案的选择及预后十分重要。201Tl再注射法、硝酸甘油介入的静息99Tcm-sestamibi法增强了心肌灌注核素体层显像对存活心肌的检测能力,门控SPECT技术能在评估心肌灌注的同时计算LVEF(左心室射血分数)、局部室壁运动和局部室壁增厚率,具有符合线路的SPECT可以进行心肌代谢显像及灌注显像,其对存活心肌的检测能力可能接近于PET,而检查费用可大大降低。     

心肌显像估测冠心病预后的价值

冠心病预后估测对于患者的进一步处理具有重要的价值。２０１Ｔｌ和９９ｍＴｃ－ＭＩＢＩ心肌灌注显像出现可逆性灌注缺损是未来心脏事件的最好预测指标；ＰＥＴ心肌代谢显像中血流代谢不匹配（血流减少，而ＦＤＧ摄取增加）同样是冠心病预后估测的重要指标。这些患者再血管化有利于改善其预后。     

腺苷药物负荷核素心肌灌注显像的护理

目的 探讨腺苷药物负荷核素心肌灌注显像诊断冠心病的护理.方法 可疑冠心病患者502例,分别静脉注射腺苷140 μg/(kg·min),用药时间为6 min.当腺苷用药3 min时静脉注入核素99m锝-甲氧异腈(99mTc-MIBI)925 MBq.用药后休息30～40 min,吃脂餐,1.5 h进行图像采集.结果 通过...     

Clinical utility of coronary calcium scoring after nonischemic myocardial perfusion imaging

BACKGROUND: Coronary artery calcium (CAC) scoring is increasingly being used after myocardial perfusion imaging (MPI) to detect preclinical coronary artery disease (CAD). However, there are few data to support this approach. METHODS AND RESULTS: We reviewed 200 consecutive patients without known CAD who were referred for CAC scoring shortly after nonischemic MPI. Of these, 13 (6.5%) had CAC scores greater than 400, indicating significant CAD; 22 (11%) had CAC scores of 101 to 400; 27 had CAC scores of 11 to 100; and the remainder (n = 138) has CAC scores of 1 to 10. Traditional risk factors and patient characteristics were not significant predictors of CAC scores of 101 or greater. However, age and the Framingham risk score were predictors of CAC scores greater than 0. At follow-up, significantly more patients with CAC scores of 101 or greater had been given the advice to take lipid-lowering medication and aspirin compared with those with CAC scores of 0. CONCLUSIONS: Of patients referred for CAC scoring after nonischemic MPI, 17.5% were identified as having CAD based on a CAC score greater than 100, allowing intervention with aggressive medical therapy. Patients who were reclassified were not easily identifiable by traditional risk factors, but Framingham risk score did predict the presence of CAC. Clinicians modified medical therapy based on the results of CAC scoring.     

负荷CT心肌灌注在冠心病中应用的初步研究进展

冠心病是因冠状动脉血流和心肌氧需求之间不平衡而导致的缺血性心肌损害,仅凭冠状动脉狭窄来诊断冠心病不能准确反映心肌缺血状况,也不能对缺血性心脏事件的发生做出较准确的预警.负荷CT心肌灌注成像则可定性及定量地评价心肌血流状态,检测心肌微循环及心肌活性,对心脏事件的发生进行预测并对早期干预提供客观依据等.对负荷CT心肌灌注的检测原理、方法及在冠心病中临床应用的初步研究进展进行综述.     

CCTA评价冠状动脉狭窄程度与SPECT心肌灌注显像关系的研究

目的：探讨冠心病患者CCTA不同狭窄程度与SPECT MPI间的关系。方法68例患者进行了CCTA和MPI检查,所有患者均行冠状动脉造影。CCTA按管腔狭窄程度分为5个级别,即0,1%~24%,25%~49%,50%~74%,75%~100%。MPI分为正常和灌注缺损(包括可逆缺损和不可逆缺损)。结果68例患者共204根血管纳入分析。以患者为单位进行分析,40例CCTA显示管腔重度狭窄的患者中,29例(72.5%)MPI显示灌注缺损。另外11例(27.5%)CCTA异常的患者心肌灌注 MPI显示正常。在28例CCTA显示未见明显狭窄的患者中,17例(60.1%)显示心肌灌注正常,而另外11例(39.9%)显示灌注缺损。根据CCTA冠状动脉狭窄程度分组,心肌灌注缺损(包括不可逆性灌注缺损和可逆性灌注缺损)出现的比率：0,1%~24%,25%~49%,50%~74%,75%~100%分别为5(27.7%)/18,1(33.3%)/3,5(71.5%)/7,4(50%)/8,25(78.1%)/32。结论冠状动脉狭窄和灌注缺损的不匹配多发生在冠状动脉中度狭窄的患者。在轻度狭窄和重度狭窄的患者中,二者多匹配。冠状动脉中度狭窄的患者应进行CCTA和 MPI联合检查评价冠心病。     

Prognostic predictors and outcomes in patients with abnormal myocardial perfusion imaging and angiographically insignificant coronary artery disease

Background. Abnormal stress myocardial perfusion imaging studies (SMPI) with angiographically insignificant coronary artery disease (ICAD) have often been labeled “false positive” scans. We evaluated the prognostic predictors and outcomes in an unselected patient population having abnormal SMPI and ICAD (study group) over a 24 month period of follow-up. Methods. Retrospective study of consecutive patients who had SMPI and subsequent coronary angiography showing ICAD within 6 months of index scan with matched control group with normal scans. Major Adverse Cardiac Events (MACE) were defined as the first occurrence of death or myocardial infarction (MI). Patients were followed up to 24 months from the time of their SMPI to identify the development of MACE. Results. One hundred and twenty five patients formed the study group and one hundred and thirty six patients formed the control group. Over a two-year follow up, approximately 13% of the study group had MACE as compared to 4.2% in the control group (P=022). Abnormal SMPI, EF<40% and chronic kidney disease (GFR<60 ml/min) were independent predictors of MACE in the study group. In multivariate analysis for MACE prediction, chronic kidney disease remained the sole independent predictor regardless of size or severity of perfusion abnormalities (P<.001). Conclusion. Patients with abnormal SMPI and ICAD have a 13% event rate of MACE over a two-year follow up. CKD seems a very important marker of a higher risk subgroup amongst such patients.     

Myocardial perfusion imaging evidence of functionally complete revascularization by minimally invasive direct coronary artery bypass in 2-vessel coronary artery disease

Background Whether patency of a second diseased vessel still impacts myocardial perfusion when complete revascularization of the left anterior descending coronary artery (LAD) territory has been achieved is currently undetermined. In patients with 2-vessel coronary artery disease and complex LAD lesions, we evaluated the impact of single LAD or integrated revascularization on single photon emission computed tomography-assessed reversible myocardial ischemia. Methods and Results Thirty-five candidates for revascularization with double-vessel disease including the LAD and a preoperative stress single photon emission computed tomography study were studied. Revascularization was performed by minimally invasive direct coronary artery bypass (MIDCAB) alone (n=15) or by an integrated procedure with second-vessel angioplasty, either soon after surgery (n=13) or at 2 months (n=7), according to the extent of reversible perfusion defects in the second vessel territory. At 1 year, the total ischemic area decreased from 9.3±5.1 to 0.8±1.5 in MIDCAB-only patients and from 8.2±4.9 to 1.6±2.9 in the integrated group (P=.87 for treatment and P<.001 for time). The ischemic area in the second vessel territory similarly decreased in both groups (P=.81 for treatment and P<.001 for time). Conclusions In 2-vessel coronary artery disease involving the LAD, MIDCAB alone achieves, in a substantial proportion of patients, functionally complete revascularization even in the nonrevascularized second vessel territory. The study was supported by grant ICS030.6 RF99/15 from the Italian National Ministry of Health.     

负荷心肌灌注显像与超声心动图对CAD患者的诊断和风险分级

负荷心肌灌注显像和负荷超声心动图是两种非侵入性诊断技术,对冠心病的诊断和风险分级具有重要价值,但两种技术均存在优势与不足。对冠心病的诊断,负荷心肌灌注显像比负荷超声心动图敏感性更高,但后者的特异性略高。在冠心病患者的风险分级方面,负荷心肌灌注显像比负荷超声心动图更有价值,如果负荷心肌灌注显像结果为阴性,即使冠脉造影证实为冠心病的患者,也提示为一个风险非常低的冠心病患者。     

Lack of correlation between coronary artery calcium and myocardial perfusion imaging

BACKGROUND: Coronary artery calcium (CAC) provides evidence of coronary atherosclerosis and has significant prognostic power. Although prior studies have documented a relationship between CAC and hemodynamically significant coronary artery stenosis, the results have not been conclusive. METHODS AND RESULTS: We evaluated 126 consecutive patients who underwent electron beam computed tomography CAC scoring by use of the Agatston method and stress myocardial perfusion imaging (MPI) within 3 months of each other. The analysis revealed no correlation between absolute CAC score and age- and gender-adjusted CAC scores with MPI. Overall, 18% of patients had abnormal MPI results irrespective of their CAC. CONCLUSION: CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for coronary artery disease.     

Comparison of dual to single contrast bolus magnetic resonance myocardial perfusion imaging for detection of significant coronary artery disease

Purpose:

To investigate the incremental diagnostic value of dual‐bolus over single‐contrast‐bolus first pass magnetic resonance myocardial perfusion imaging (MR‐MPI) for detection of significant coronary artery disease (CAD).

Materials and Methods:

Patients (n = 49) with suspected CAD underwent first pass adenosine stress and rest MR‐MPI and invasive coronary angiography (CA). Gadolinium diethylenetriamine pentaacetic acid (Gd‐DTPA) was injected with a prebolus (1 mL) and a large bolus (0.1 mmol/kg). For the single‐bolus technique, the arterial input function (AIF) was obtained from the large‐contrast bolus. For the dual‐bolus technique, the AIF was reconstructed from the prebolus. Absolute myocardial perfusion was calculated by Fermi‐model constrained deconvolution. Receiver operating characteristic (ROC) analysis was used to investigate diagnostic accuracy of MR myocardial perfusion imaging for detection of significant CAD on CA at vessel‐based analysis.

Results:

The area under the curve (AUC) of the minimal stress perfusion value for the detection of significant CAD using the single‐bolus and dual‐bolus technique was 0.85 ± 0.04 (95% confidence interval [CI], 0.77–0.93) and 0.77 ± 0.05 (95% CI, 0.67–0.86), respectively.

Conclusion:

In this study the dual‐bolus technique had no incremental diagnostic value over single‐bolus technique for detection of significant CAD with the used contrast concentrations. J. Magn. Reson. Imaging 2010;32:88–93. © 2010 Wiley‐Liss, Inc.